Provider Demographics
NPI:1902468564
Name:ADENIMIRAN, OLUWOLE HENRY (LVN)
Entity type:Individual
Prefix:MR
First Name:OLUWOLE
Middle Name:HENRY
Last Name:ADENIMIRAN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:MR
Other - First Name:OLUWOLE
Other - Middle Name:HENRY
Other - Last Name:ADENIMIRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:3902 MIDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3746
Mailing Address - Country:US
Mailing Address - Phone:310-853-9116
Mailing Address - Fax:
Practice Address - Street 1:4434 HARDING AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6123
Practice Address - Country:US
Practice Address - Phone:310-853-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243165164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse